Want to help patients transform their lives? It’s time to learn the art of motivational interviewing. This helpful psych-focused approach to care helps patients become accountable, find inspiration to make positive change, and live longer and healthier. The foundation of motivational interviewing is to meet patients where they are. By validating their experiences and displaying empathy, you can seamlessly push patients past pre-conceived hangups and change behavior long-term. Here, we break down motivational interviewing into step-by-step techniques.
The OARS Skills for Motivational Interviewing
The OARS skills are the foundation of effective motivational interviewing. This framework was developed by Dr. William R. Miller and later expanded in collaboration with Dr. Stephen Rollnick. Each step leads a patient further in the journey toward a more balanced lifestyle. These strategies can be integrated into patient communications and can be tailored to each individual’s specific needs and challenges. These challenges may include substance use disorder (SUD), chronic disease management (obesity, heart disease, diabetes), and smoking cessation, but these principles can also be applied elsewhere.
Open-Ended Questions
Try framing questions in ways that warrant more than a “yes” or “no” response. This will both help patients explore their feelings and challenges, while also helping you better understand their state of mind. Open-ended questions will also create an equal playing field with patients: they will feel less like they are being interrogated and more like they are having a candid conversation with someone who cares. Open-ended questions help patients come to conclusions in their own time, rather than being lectured and fed appropriate responses.
Examples:
- What matters most in your life right now?
- What do you think needs to change before you feel healthy and fulfilled?
- What is stopping you from quitting your drug of choice?
- How has (insert unhealthy lifestyle practice here) negatively affected your life?
Related: Precision Medicine in Psychiatric Care
Affirmations
In motivational interviewing, affirmations are statements that aim to celebrate what the patient is doing right, giving them confidence and encouraging them to adopt other positive behaviors. This can help clients who deal with low self esteem, mood disorders like depression, or those who deal with ups and downs related to sobriety and weight loss.
Examples:
- You’ve shown a lot of strength in staying clean these last few weeks.
- It took courage to talk honestly about your struggles
- You’ve clearly been thinking a lot about how to change things.
- Even showing up here today tells me you’re taking this seriously.
Reflective Listening
This includes listening clearly to what your client is saying and “mirroring” the core ideas in your own words. This helps patients feel seen and understood. By practicing reflective listening, clients can both celebrate wins, and conversely, see where they may be displaying logical fallacies. You can either paraphrase what the client says, or dig deeper and express the true “meaning” of a client’s words. It’s important to avoid judgement and scolding, “put words in their mouth”, or project your own feelings onto what the client is saying.
Examples:
- Client: “I’m only here because the court told me to come.”
- “You feel this isn’t really your choice.”
- “It’s frustrating to feel forced into something you’re not sure you need.”
- Client: “I don’t think I have a drug problem, but my partner says I do.”
- “You’re not convinced there’s an issue, but you care about how this affects your relationship.”
- Client: “I don’t think smoking effects my health as much as my medical team tells me.”
- “You personally don’t see the harm in this habit, but medical professionals say otherwise. I understand why you feel conflicted.”
Related: Comprehensive Psychopharmacology for NPs and Advanced Practice Clinicians
Summarizing
Sometimes, a conversation with a medical provider can be a lot to take in for a patient—especially if it has to do with a sensitive subject. At the end of your motivational interviewing session, be sure to summarize what was spoken about and what patients need to focus on outside of the clinic. This shows that you were intently listening to what the client said, and also reinforce their own role in their treatment protocol.
Examples:
- “So far, you’ve talked about wanting to stay out of prison, reconnect with your daughter, and work on your drinking. Those seem really important to you.”
- “Last time you mentioned wanting to go back to college. Today you’re saying you’ve started looking at courses. That’s a big step.”
- “You’re still unsure if you want to stop using completely, but you said you’re tired of the consequences. Is that something we could explore more?”
Key Takeaways
Using OARS for motivational interviewing is an actionable way to make client communication more productive. Your role as a clinician is to guide patients toward lifestyle modifications that work for them, while avoiding pushiness or self-righteousness. You should be a safe space for patients to feel heard and supported through life’s ups and downs. By building trust, you can establish yourself as a crucial resource for patients forging a new, more positive path.
